Y HOC VlfT NAM THANG e - SO Z/2014 Korean Joumal of Intemai Mediane, March; 24(1),
pp.48-54.
Kudoh S, Kato H, Nishiwaki Y, et a l . Interstitial lung disease in Japanese patients with lung cancer: a cohort and nested case-control study. Am J Respir Cn't Care Med.
2008; 177(12): 1348-1357.
Mok S.T, Wu Y.L, Thongprasert S, Yang C H , Chu D.T, Saijo N et al (2009). "Gefitinib or Carboplatin-Paclitaxel in Pulmonary Adenocarcinoma", N Engl J Med ; 361: 947-57.
Narumi S, Inoue A, Morikawa N, et al. First- line gefitinib for elderly patients with advanced
non-small cell lung cancer (NSCLC) harboring EGFR mutations: a combined analysis of NE]
studies. Jain Oncol. 2012;30 Suppl:abstr 7563.
Rafael Rosell, Enric Carcereny, Radj Gervais, Alain Vergnenegre, Bartomeu Massuti, Enriqueta Felip e t a l , Eriotinib versus standard chemotherapy as first-line ireatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial,, Lancet Oncol 2012 DOI:10.1016/S1470- 2045(11)70393-X
DANH GIA KET QUA CUA PHAU THUAT NOI SOI
TRONG CHAN THU'ONG NGU'C TAI KHOA NGOAI BENH VIEN BACH MAI
T6IVI TAT
Muc t i e u : Danh gia ket qua cua phau thuat npi SOI long nguc trong chan thu'dng ngi/c. Doi tu'dng va phu'dng phap: Hoi culi mo ta cSt ngang gom 50 benh nhan sau chan thu'dng ngu'c (30 trUcJng hdp) va v§t thu'dng ngUc (20 tru'dng hpp) dUdc iihg dung PTNS de dieu tri. Gom 45 nam va 5 nff, tuoi tff 18-67 trung binh 47,3±5,2 tuoi, giai doan 2008 den 2012 tai khoa Ngoai benh vien Bach Mai. Ket qua: Tat ca cac thffdng ton deu du'dc xff ly qua npi soi ngffc khong trffdng hop nao phai chuyen mo md, dat dan Iffu khoang mang phoi 28 TH. Thdi gian nam vien sau mo 2,3±1,7 ngay. Khong cd tff vong trong va sau phau thuat. Co 4 TH con tran khi va mau mang phoi sau phlu thuat. Khong c6 di chffng sau phau thuat. Nhiim khuan v ^ mo ITH va khong co viem mil mang ph6l sau m6, Ty le bien chffng sau phau thuat 5,76%. Theo tieu chuan xep loai: Loai tot: 48/50 chiem 96%. Loai trung binh: 2/50 chiem 4%. Khong cd ket qua: 0/50.
Ket l u | n : PTNS long ngffc trong cap cuXi la an toan va cd hieu qua, thdi gian nam vien nocin, hau phau ddn gian, khong co cac di chffng sau phau thuat.
Titkh6a:Cn%r\ thffdng ngffc. Phlu thuat npi soi S U M M A R Y
REVIEW OF RESULTS LAPAROSCOPIC SURGERY OF T H O R A C I C T R A U M A I N THE
HOSPITAL BACH M A I Objective: To evaluate the results of endoscopic thoracic surgery in thoracic h-auma . Subjects and
* ld)oa Ngoai - BV Bach Mai
Phan bl$n khoa hgc: PGS.TS Phgm Thien Ngpc
Tr4n Vinh*
Methods: In cross-sectional descriptive study included 50 patients after chest trauma (30 cases) and chest injuries (20 cases) is used to treat endoscopic. 45 male and 5 female, aged 18-67 average 47.3 ± 5,2 years, between 2008 and 2012 at the Department surgery of Bach Mai Hospital. Results: All the lesions were processed endoscopic breast no circumstances should switch to open surgery, drainage of die pleural cavity placed 28 patients . Postoperative hospital length of stay 2.3 ± 1.7 days . No deaths during and after surgery. There are also 4 TH emphysema and pleural blood after surgery. No postoperative sequelae. Ith wound infection and no postoperative empyema. The rate of complications after surgery 5,76 %. According to the classification criteria: good Type: 48/50 accounted for 96 %. Medium: 2/50 is 4%. No result:
0/50. Conclusions: Endoscopic In emergency chest Is safe and effective, shorter hospital stay postoperative simple, no postoperative sequelae.
Keywords: Chest injuries, Laparoscopic surgay
I. D A T V A N OE
Chan thu'ong ngyc (CTN) la mpt cap cijftJ ngoai khoa nang va thu'dng gap, chiem khoang 7 , 1 % cap ciru ngoai chan thffdng [ 2 ] , Bien phap dieu trj chii yeu la dan \du mang phoi toi thieu.
Mpt so trffdng hdp nSng doi hdi phai md ngffc cap cffu, nhffng quyet djnh khi nao can md ngi/c van luon la nnpt van de kho. Nhu^g nam gan day cung vdi viec ap dung phau thuat npi sol 6 bung trong cap ciru, npi soi ldng ngyc cung dang diAjc '^nq dung trong cap cirU vi cac ulj the cita no. Do la hieu qua cua PTNS quan sat rdng, xff ly hifu
Y HQC VIET HAM THAHG 6 - SO 2g014 qua cac thffdng ton nhff nw md ma hau phau ddn
gian, ngffdi benh phuc hoi sau chan thffcfng nhanh, khdng co cac di chirng cua n>d ngffc, nhiem khuan sau mo thap va cd ti'nh tham mT cao.
Tai khoa Ngoai benh vien Bach mai tff nam 2002 chung tdi d3 ap dung phau thuat npi soi long ngffc trong chan thffdng cd ket qua tdt [1].
Nghien culi nay chung tdi trinh bay cac chi dinh, ky ttiuat va ket qua npi soi long ngffc trong giai doan nay.
II. cdl TU'ONG vA PHU'ONG PHAP NGHIEN CUU 2.1. Doi tu'dng nghiSn cCfu: Nhuhg benh nhan bj chan thffdng hay vet thffdng ngffc dffdc sd ciru nhff khau kin vet thffdng, dan Iffu mang phoi hoac khdng, cac thffdng ton phoi hdp khac nhff: cd djnh xffdng sffdn gay dffdc xff ly tai phong kham ciia khoa Ngoai hoac tff tuyen dffdi chuyen len. Tat ca dffdc nhap vien dieu trj, theo doi theo mpt phac do thdng nhat tai khu cap cffu ciia benh phong.
2.2. Phu'dng phdp nghien cu'u: Mo ta hdi ciru
2.2.1. Chi dfnh n§i soi idng ng^c:
• Cac chi dinh npi soi ngu'c cho cac trffdng hop nay khi:
- Bfnh nhSn c6 bieu hidn ISm sang kho thd, mach huyet ^p kh6ng dn dinh,
- C^c dau hIeu nay cho thay chay mau hay tran khi khoang mang phoi tai phat nhanh.
- Cdc trffdng hdp dan Iffu mang phoi ma khong cd ket qua; so Iffdng mdu ra nhieu, khdng giam sau dat dan iffu.
-Tren phim XQ long ngffc xac dmh co tran dich hoSc khi trong khoang mang phdi. Trong nhuTig trudng hdp khd xac djnh dffdc chup CTS long ngffc xdc dfnh ca mau cue trong mang phoi, ghi ngd tdn thffdng phoi hodc cac tdn thffdng khac phoi hdp.
- Khong cd chi djnh ndi soi long ngu'c khi:
- Th^ trang chung khong on dinh
- Mat mau cap tinh do tdn thffdng cac mach mau ldn hay tim
- Cd cac thutrng tdn phdi hdp khac: cac tang trong bgng, sp nao (Sn phai can thiep hay theo doi.
2.2.2. K9thu$t:
• Phddng d$n: Dung cu npi soi long ngffc ia bd ndi sol cua hang Kart-Storz vdi he thdng camera, dng kinh nghiSng 30", nguon sang, bdm hdi C02, mdy hut, dao dien va cdc dung cu thao tdc nhff cdc Trocars 10mm, 5mm, que ven phdi.
phau tich, dung cu khau, ddt. Bd dung cu phau thuat md ngu'c dff phdng.
- / ^ diuat: JaX. ca t)enh nhan dffdc gay me ndi khi quan vdi dng khi quan 2 nong kieu Carlens.
Benh nhan nam ngira vcfi tff the ben ngffc se dutfc tham dd nghieng cao hdn ben ddi dien khoang 25°-30°, Cd ddn gdi phia dffdi de lam gian khoang lien sffdn. Vj tn dat trocar: Itrocar 10mm khoang lien sffdn VI nach sau danh cho opic, 1 trocar 5mm hd nach va 1 trocar 5mm khoang lien sffdn IV nach trffdc danh cho dung cu.
- Kiem tra, danh gia thddng ton: Sau khi hut het mau, mdu cue, tim cac thu'dng t^n gay chay mau nhff: vet thffdng thanh ngffc do xffdng sffdn gay chpc vao, vet thffdng xuyen thanh ngffc sau khi da khau ben ngoai nhffng Id thanh van cdn chay mau. Cdc vet thffdng khde nhff vet thffdng nhu md phdi, mang tim, cd hoanh neu cb. Sau do chiing toi xff ly cac tdn thffdng nay tuy theo mffc dp nhff ddt dien vdi cdc vet thffdng thanh ngffc ri mau, phai khau khi cd vet thffdng Idn, chay mau.
Vdi cac tdn thffdng phdi cd th^ khau khi rach, cdt khdng dien hinh phan nhu md ndt hoac dung dap. Khau cd hoanh, mang tim,.
- Sau khi xff trf cdc thffcfng tdn, khoang mang phdi dffdc rira ky bang dung djch huyet thanh man 0,9% va ket hdp vdi gay me cho nd phdl hoan toan, riit cac trocars, dong da cac lo cd hoac khdng dan Iffu Idng ngffc.
- Sau md, tinh trang cua ben ngffc bj tdn thffdng dffdc theo ddi tien trien tren lam sang va X quang nham phat hien cdc dien bien bat thffdng nhff tran mau, khf tdi phdt, nhiem khuan mang phoi,.
III. KET QUA 3.1. Oac diem chung:
Tff thang 1-2008 den 12- 2012 trong sd 122 trffdng hdp chan thffdng ngffc, chiing tdi da tien hanh phau thuat npi soi long ngffc. Trong dd 50 trffdng hdp (TH) du tieu tri cho nhom nghien cffu nay. Gom: nam gidi 45 TH, nff 5 TH vdi dp tudi tff 28,5±13,1. Trong do co 52 thffdng tdn khoang mang phoi va 20 TH vet thffdng hd da dffdc xff iy khau kin.
Nguyen nhan do;
- Tai nan sinh hoat: 38/50 BN (76%) - Tai nan lao ddng: 5/50 BN (10%) - Tai nan giao thdng: 7/50 BN (14%)
3.2. Oic diem lam sang vd c$n \hm sdng 3.2.1. Dau hieu iim sing diinh: Dau ngyc vung bj thffdng' tdn la 100%, ludn kem theo bieu hien khd thd. Giam ri rao phe nang chiem 48/50 BN chiem 96%.
Y HOC VIET NAM THANG 6 - SO 2/2014 3.2.2. Dau hieu can iam sang:
XQ long ngu'c:
- Ket qua tren phim XQ long ngffc thffdng qui; Tat ca cac benh nhan deu cd tran mau va khi ket hdp.
- Ket qua tren phim CTS long ngu'c: Ton thffdng ngffc: ben phai 18 TH, ben trai 30TH, ca 2 ben 2TH.
I
Hinh anh XQ va CTS long ngdc BNNGVANT,57 tuoi* Cic thddng ton phoi hdp:
• Gay xu'dng canh tay cung ben : - Gay xildng don;
- Gay xu'dng su'dn:
- Ton thu'dng cac tang trong bung:
- Gay xu'dng dui:
*Cic xit nghiim khic:
- So lu'dng hong cau'tru'cSc mo: trung binh 3tr26, thap nhat 2tr4 cao nhat 3tr8.
- Bach cau: trung binh 8200.4, thap nhat 6500, cao nhat 12000.
-15 TH dUdc do chu'c nang ho hap tru'dc mo ^ u co giam thong khi d cac chi so . 4 bentrai
5 trong do 3 ben trai, 2 ben phai.
32 (trong do gay tren 2 xu'dng d 21 binh nhan).
1 trirdng hdp thung rupt non.
2 tru'dng hdp ben trai.
3.3. Ccic thu'dng ton trong dddc danh gia qua no! soi:
3.3.1. CM dinh phiu thuit not spl:
• Tran mau, tran \i\\ l<hoang mang phoi tai phat nhanh sau i<hi da dUdc choc hut 10 TH, va 15 TH sau l<hi da dUdc choc hut va dan iuu i<hoang
mang phoi i<in hiit iien tuc du'di ap suat am • 20cm H2O
- Co mau cue trong l<hoang mang phoi 15 TH.
- Tran Vii niianh nghl ngd cd ton thu'dng phoi 10 TH, 3.3.2. Cic thu'dng ton khi ngi soi:
Bing 3.1: Cac thUdnq ton thu'dng ton Tran mau KMP 500-lOOOml Mau cue tronq KMP Ton thUdnq tnanh nqUc Vet thu'dng phoi Dunq dap nhu mo phdi Vet thu'dnq cd hoanh Vet thu'dnq mant^ nqoal tlm
Di vat khoanq mancj phdl qay thunq phdl va cd hoanh Thu'dnq tdn mach idn trunq that
n 50 30 27 13 12 2 3 1 0
100
%
57,69 51,4
2k
23 3,8 5,76 1,92 0 Nhan xet: 100% trudng hdp co mau trong khoang mang phoi. Trong dd 50% do ton thu'dng thanh ngUtThung cd he - Ky thuat dan li/u KMP
Y HOC VlfT NAM THANG 6-SO2g014 Benh nhan Tran Anh T 27 tudi
B^nh nhan Du'dng Trung D 30 tuoi
Tat cade trddng hop deu dddc hut hit mau, mau cue, rda mang phoi, xd ly cac thddng ton:
3.3.3. Cickyihujtxu'iy:
Ky thuat xir ly thu'dng ton Cam mau thanh ngu'c
Khau vet thu'dnq phoi Khau cti hoanh C3m mau, md manq tim CSt phoi dap khong dien hinh OSt dan luU khoanq manq phoi sau mo
n 27 13 2 3 3 18
51,69
%
26 3,8 5,76 5,76 34,6 Nh$n xit: Ty le dat dan Iffu khoang man phoi chiem 34,6%
3.4. Ket qua sau phau thuat:
Thdi gian md trung binh 40,5phut ( 35-68 phut) - Kliong cd trffdng hdp nao phai chuyen md md.
Thdi gian nSm vi^n sau md trung binh (2,3 ± 1,7 ngay) - Cdc bien chffng sau phau thuat:
Bing 3.4: Cdc bien chirng:
Bien chii'ng sau phSu thugt Chay mau tai phat khoang mang phoi Tran khi tai phat khoang mang phoi Nhiem trung
Tran mu mani ig phoi
Nh$nx4t:J<i le b l ^ chffng sau phau thuat 5,76%
- Theo tieu chuan xep loai:
- Loai tdt: 48/50 TH chiem 96%
- Lo?i trung binh: 2/50 TH chiem 4%
- Khdng co ket qua: 0/50 TH chiem 0%
IV. BAN LUiBiN 4.1. D$c dl€m Chung
Noi soi long ngffc da dffdc tien hanh bSng ong effng tff nhOhg ndm 20-40 the ky trffdc, htnh anh dffdc nhin trffc tiep bj han che do nguon sdng. Ndm 1922 Jacobaeus (Stockholm) da bao cdo kinh nghiem 12 ndm cua minh trong ndi soi long ngi/c^de chein doan vdi cac benh chii yeii ciia mdng phoi, Vi h?n che ciia nguon sang nen cdc phau thu$t vien nhin quan sat khoang Idng ngffc rSt khd khdn. Do vay soi mang phoi trong glal do^n trudc cQng chi dimg lai d mffc dp chan dodn.
_i,92_
1,92
Nhffng nhu'ng nam gan day nhd irng dung cua cdc Ioai cong nghe: ngudn sang cffc manh dffdc dan truyen qua cap quang vdi lie thdng kinh Hoppkin cd dp phdng dat nen hinh anh quan sdt dffdc trong lite npi soi long ngffc idtic nhin rd hdn, £^ng thdi vdi Camera ky thuat sd ghi hinh anh va phdt ra ngoai qua man hinh (Video). Hinh anh trong long ngffc dffdc truyen ra ngoai nen nhieu ngffdi cimg quan sat dffdc ciing jndt liic ma ngu'di ta ffng dung nhieu loai hinh phau thuat nay trong Idng ngffc (VATS - Video-assisted thoracoscopic Surgery) de chan doan va dieu tri cac benh: tran khf, mdu mang phdi u trung thit, u phdi, ngffc dac biet sau chan thffdng ngffc. VATS
Y HOC V l ^ NAM THANG 6 - SO 2/2014
da to ra rat hieu qua va an toan theo hau het cac thong bao tren Y van. [1], [2], [3], [4], [5],
Tran mau, khi trong long ngUc sau chan thu'dng hay vet thu'dng trudc day thudng dxSdc choc hut hay dat ong dan iUu mang phoi toi thieu hoac md ngUc nhuTig cd cac nhu'dc diem sau;
- Keo dai thdi gian sau mo.
- Cham sdc cua dng dan \\Su phu'c tap de cd nguy cd tran khi, nhiem khuan.
- Oac biet nhiJTig tru'dng hdp cd mau cue trong mang phoi thi viec choc hui: khong cd hieu qua, kha nang nhiem khuan va viem mu mang phoi gay ap xe, 6 can hay day dinh gay keo dai thdi gian nam vien cho ngu'di benh va anh hu'dng tdl su'c khoe chung cua ngu'di benh sau nay.
- Nhi?ng tru'dng hdp phai md ngUc thi sau md cd nhieu dl chiihg: lian che ho hap, dau va thieu tham my.
4.2. Chi d|nh phau thuat
4.2.1, flIliGhg du diem cua phau thuit ndi soi long ngdc:
Viec ap dung VATS trong cac tru'dng hdp tran mau, l<hi mang phdi cd cac diem ich ldi sau:
- Npi soi long ngUc da dUdc tien hanh bang dng cuing tCr nhiihg nSm 20-40 the ky trUdc, hinh anh du'dc nhin tryc tiep bj ban che do nguon sang.
Nam 1922 Jacobaeus (Stockholm) da bao cao kinh nghlerri 12 nam ciia minh trong ndi soi long ngUc de^chan doan vdi cac benh chu yeu cua mang phoi. Vi han che ciia nguon sang nen cac phau thuat vien nhin quan sat khoang long ngiTc rat khd khan. Do vay sol mang phdl trong glal doan tru'dc cung chi dimg lai d mirc dp chan doan.
- Nhanh chdng glal quyet mau trong mang phdi, tim va loai bd cac thudng ton chay mau, tran khi ngay nen han che thdi gian nam vien cho ngu'di benh.
4.2.2. That gian nio nin chi dinh phau thuit?
* Wpf van de dat ra la chi dinh PTNSLN idii nao ii hdp /y.^'Dleu nay con cd sir ban cai giu'a cac tac gia. Theo Carrlllo, Richardson la dudi 7 ngay. Theo Lang-Lazdunski la dudi 10 ngay, tac gia ghi nhan nhutig tru'dng hdp mau cue mang phoi tren 10 ngay se rat khd khan trong viec xiJ ly [5]. Chung toi cung ciing ghi nhan vdi tac gia , Navsaria va Pham WISu LU: nhifng tru'dng hdp ton thu'dng mau cue mang phoi cd thdi gian tren 7- 10 ngay, khi hpi sol thay: khoi mau cue bj to chu'c hda rat khd lay, khi lay de chay niau, gay ton thiTdng nhu^ md phoi cd the dan den ro khi keo dai sau phau thuat neu bd sdt thu'dng ton nay. Va thdi gian ijhau thuat bj keo dai [3].
* Chi djnh phau thuat npi soi long ngdc trong nhuhg trddng hdp nio?
Theo Chung tdi chi djnh PTNSLN doi vdi chan thu'dng long nguc ve cd ban ciing nhu ehi djnh mo md long ngiTc, dd la:
+Tran mau, tran khi mang ^hdl tai dien nhanh sau khi da choc hut hay dan lUu khoang mang phdl. Nguyen nhan thu'dng do cd cac ton thu'dng mach mau d thanh ngi/c hav^ nhu mo phdi khdng tU cam lai ddcSc, hoac do ton thu'dng nhu md phdl khdng t i / bit lai duuc^ Trong nhijlng trirdng hdp nay ndi sol mang phdi^vira cd tinh chat dieu trj vira cd tinh chat chan doan xac djnh. Do do khdng nen chpc hilt hay din liAi khoang mang phdi rdi chd xem mau cdn chay tiep niTa hay khdng. Oieu nay cung dUdc cac tac gia khac ghi nhan.
Vdi cac tru'dng hdp vet thu'dng phdl gpn VATS td ra rat cd tac dung, can ket hdp vdi giy me hay bdm them nUdc vao khoang mang phoi cac vj tri vet thu'dng se du'dc phat hien, sau do chung tdi khau Ial bang chi Dexon 3.6 . Neu co dieu kien vdi cac vet thUdng rdng cd the cat mot phan phdl bang cac stappler
Nhu'ng trudng hdp dung dap nhu md piifil theo chiing tdi neu Itlidng cd rach thi chi ran lam sach mau mang phdl va lam cac phan phdl khac nd va ket hdp dieu trj sau mo, chi nen cat nhiJBg phan dap nat bang stappler.
Trong nghien ciru ciia chiing tdi cd 3 tru'dng hdp vet thu'dng mang tlm nhu'ng lam sang khong cd bleu hien chen ep tim cap vi mau chay ra khoang mang phdl. Chung tdl gap 3 vet thu'dng cd hoanh 2 ben trai deu cd chan doan tru'dc mo nhd chyp CT ngyc
+ l<hl cd mau ddng trong khoang mang phoi:
Do mau b] ddng Ial trong khoang mang phdi nen khdng the lay bd sach du'dc bang nhij'ng bl^
phap nhir chpc hut, bdm riSa hay dan luti khoang mang phdl. Khdi mau ddng nay ta mdi trUdng de vi l<huan phat trien dan den bien chii'ng mil mang phdl hoac gay day dinh mang phdi.
Trong sd cac benh nhan ciia chung tdi cd 30 tru'dng hdp cd mau cue nhiJnq tru'dng hdp nay hut^dan luu se khd khan va de cd nguy cd viSm nhiem va day dinh. Trong dd cd mdt sd trUdiKI hdp cd ^ cd nhieu sdi dinh mii mang phoi (Fibropurulant empyema - ioai I I cua Light) se khdng dap iTng vdi khang sinh va chpc hut thdng thydng budc phai md ngyc nhu tr'ydc day &
dUdc thyc hien tot bang VATS.
+ Cd dj vat nam sat mang phdi; Trong nhom nghien cisu cua chung tdl cd 1 trydng hdp BN b|
phoi bao ciia may phay gay tdn thu'dng thanh ngyc, cd hoanh phai va phdi. Chi dinh cho nhifng trudng hdp cd di vat da dUOc Pham Gia Khinh ghi nhan 3 tru'dng hdp lay quj NSIIN thanh cong cd dau dan nam sat mang phdi [2].
Trong dieu kien chuS dupc trang bj cac dgng cu chuyen biet cho phau thuat ndi soi long ngi/t thi viec chi djnh phau thuat ndi sol long ng\lt cang can phai can nhac chat che vi neu phai nil
Y HOC Vl|T NAM THANG 6 - SO 2/2014 ly cac thffdng tdn phirc tap^ nhff; ddng cac ton
ttiffdng rpng cua nhu md phdi, cat mdt ttiiiy phdi, hoac cac ton thffdng mach Idn thi cac dung cu phau thuat npi soi thdng thffdng khdng the thffc hien dffdc. Npi soi va nhij'ng thao tac ky thuat va phffdng tjen con han che se lam nguy hiem them cho tJnh bang mat mau ciia ngffcfi benh. Ngay ca cdc trung tam Idn ve long ngffc ngffdi ta cung khong chi dinh VATS trong cac trffdng hdp m§t mau nang, the trang ngffdi benh khdng dn dinh [5], [6], [7].
+ Ket qua npay sau mo:
Ngay sau mo cac benh nhan ciia chung tdi dffdc tiieo doi tai khu hau phau: cd 1 trffdng hdp chay mau tai phat va 1 tran khi sau 24 gid vdi khdi Iffdng it (khoang 200ml dffdc chpc hut 1 lan vd ket qua tdt).
Vdi ket qua ngay sau md thdi gian nam vien ngdn trung binh 5,5 ngay cham sdc sau md ddn gian^ benh nhan |t dau sau mo, khdng cd nhiem Idtuan mang phoi ma ngffdi benh khdng phai chju md Idng ngffc nhff trffdc day. Chiing tdi thay ket qua rat dan^ khich le cua phffdng phap cung nhff nhan xet cua hau het cac tdc gia khac VATS Id mpt ky thuat an toan va cd hieu qua cd nhieu ffu diem hdn so vdi dan Iffu mang phdi hay md ngffc [3], [4], [5], [6], [7].
V. K ^ LUi3kN
Qua thffc hien npi sol Idng ngffc trong phau thu$t dp dung tren 50 benh nhan vdi 52 trffdng hdP chan thudng ngu'c tai khoa Ngoai benh vl$n Bach Mai trong thdi gian qua chiing t6l thay:
Day la mpt ky thuat an toan va hieu qua vdi ngudi b$nh, VATS da rut ngSn thdi gian ndm vien So ngudi benh, han che phai md ngut d cdc benh nhdn cd mdu cue, da^ dinh sdm mang phoi sau chan thudng, CSn co so ludng va thdi gian theo doi
nhieu hdn de cd cac chi dinh hdp ly va sdm cua npi soi lor^ ngffc trong chan thffdng ngffc.
Co the diing bp dung cu Phau thuat ndi soi thdng thffdng de xff ly dffdc phan ldn cac thffdng ton trong cac trffdng hdp chan thffdng ngffc
Can tang cffdng dao tao cac phau thuat vien md Phau thuat npi soi long ngffc. Dong thdi trang b| ddng bd cac dung cu cJiuyen l<hoa npi soi long ngffc de cd the xir tri dffdc cac ton thffdng phu'c tap hdn.
TAt UEU THAM KHAO
1. Nguyen^Ng9C Bich va CS (2010); "Ket qua ap dung phau thuat npi sol trong chan thudng ngut tai benh vien Bach Mai". Ngoai khoa. Tap 60, sd 4-5-6/2010; tr: 324-330.
2. Pham Gia Khanh, Ngo Van Hoang Linh (2d04);"Mpt ^ nhan xet ket qua bffdc diu dieu tri vet thffdng phol-mang phdi bang phlu thuat noi soi long ngffc tai BV 103"; YHoc ThuCh^n'h, 50 491; tr: 394-398
3. Pham Hihi Lff va CS (2006); "Ket qua phlu thuat noi sol long ngffc cap citU tai Benh vi?n Viet-Oirc". YHoc Viet Nam, Tap 319; tr:'422-428 4. Nguyen Minh t r i va cong su* (2004); "Dieu tii
tran mau mang phoi trong chan thffdng ngffc bSng phau thuat noi soi Idng ngffc". Y hoc Thut hanh, so 419; ir: 341-343.C
5. Carrillo EH, Richardson JD (2005)/Thoracoscopy for the acutely injured patient"; The American Journal of Surgery 2005;
190:234-238.
6. Celik M, et al (1998); "Video-assisted thoradc surgery: experience witti 341 cases".fi/r 3.
Cardiodiomc Surg; 14:113-6
7. Cunniff MG, Maguire D et al ( 2 0 0 0 ) ;
«Video-assisted thoracoscopic Surgery in the management of loculated empyema"; Surgiol Endoscopy V14,N2 Feb; 175-178.
DAC DIEM DICH TE HOC BENH TAM THAN PHAN LIET TRONG CONG DONG TAI QUAN LE CHAN, H A I PHONG NAM 2 0 1 3
T 6 M TAT
M^ic tiSu: Md ta ty le mdc va ddc diem djch te hpc ciia b^nh tdm than phan 1i|t trong cpng ddng t^i qu|n Le Chin, Hai Phong nSm 2013. Phu'dng
' Tn/dng 0^1 hgc Y Dupc Hal i^ong
Phin b/^ khoa hgc: GS.TSKH Nguyen VSn Hieu
Ph^m Minh KhuS*, Pham Vgn Manh*
phdp: Nghien ciTu mo ta cdt ngang tren toan bp dan cff quan t i Chan, Hal Phong. Ngffdi nghl ngd mdc benh dffdc gia dinh, cpng tac vien y te van dpng dSn kham phat hien benh tai tram y te phffdng vd chan doan xac djnh bdi bac sy chuyen khoa dira tren tieu d l i cua To chffc Y te the gidi (ICD-10). Ket qua: Ty I?
mdc diem cua benh nhan TTPL d quan Le Chdn la 0,12%; trong do nam la 0,16 % va ni? 0,1%. Ty I?
